In a policy equivalent of Noah building an ark and warning his neighbors about a Great Flood, David Williams, then president of the Kentucky State Senate, began warning of the impending collapse of the state’s pension system in the early 2000s. Nearly every one of Kentucky’s pension systems were near or above full funding though, how could they be on the pathway to collapse? The “Bully from Burkesville" was at best trying to engineer a crisis and at worst crazy, his critics rebutted.

Less than two decades later, his loudest critics and Kentucky’s pension system are both underwater. Kentucky has the worst-funded pensions in America. Trying to maintain the structurally deficient system now requires approximately 10 percent of the state’s small budget, crowding out or limiting nearly every other government program.

On Aug. 30, the commonwealth’s recently appointed secretary of Health and Family Services, Adam Meier, testified before the Budget Review Subcommittee for Human Resources. The state’s Medicaid program, which is already nearly larger than the entire state budget, is facing a $300 million shortfall over the next two budget years, thanks in large part to the state’s ill-conceived adoption of Medicaid expansion.

Meier did not set out to prophesy on the state’s fiscal future, but the takeaway is clear. Kentucky is on an avoidable pathway to bankruptcy.

There are at least two reasons for conservatives to support eliminating Medicaid expansion to help fix this problem. The first is simple arithmetic. Since just after the implementation of the Great Society, government entities have explored incalculable theories on how to restrain growing health care costs. They have all failed. In the last 50 years, health care spending has outpaced GDP growth by nearly 2.5 percent annually, making a massive difference over time. In 1960, health spending as a share of GDP was approximately 5 percent. By 2013, the year before Kentucky adopted Medicaid expansion, health care spending had grown to 17.4 percent of GDP. By 2025, health care spending will rise to nearly 20 percent of GDP.

Since Medicaid is a joint program between states and the federal government, the costs are split between them. Because Kentucky is a poor state, the Federal government assumes the majority of the cost for the traditional Medicaid population, covering 71.8 percent compared to the commonwealth’s 28.2 percent. Knowing full well that states would be reluctant to take on additional health care expenses, Obamacare covered the full cost of services for expanding the program when it was first adopted, but only temporarily. By 2020, Kentucky will be forced to pick up 10 percent of the bill for the expansion population.

The problem here is self-evident. Nearly 1.4 million people in Kentucky are on Medicaid and about a third are part of the expansion population. As health care costs continue to rise, which the U.S. Centers for Medicare and Medicaid Services expect it to do by 5.3 percent in 2018, and Kentucky is forced to assume a higher percentage of costs, there is virtually no pathway where it is sustainable to maintain Medicaid expansion. At least not without significantly raising taxes on middle-class workers and destroying the state’s job growth.

For conservatives, a second reason is equally important. Conservatives are generally comfortable with a social safety net and generally leery about the welfare state. There is an important distinction between the two for measured effectiveness. Medicaid is a largely ineffective welfare policy. Not only does it carry high costs and perverse incentives, there is little evidence it accomplishes its stated goals. A 2013 study led by researchers from Harvard and MIT and published in the New England Journal of Medicine — the most prestigious peer-reviewed medical journal in America — found that Medicaid coverage “generated no significant improvements in measured physical health outcomes.”

If Kentucky can’t afford Medicaid expansion and there is no evidence that it is improving our abysmal health outcomes anyway, it seems obvious that it should be eliminated. Kentucky is in need of policies that improve our health care outcomes. Medicaid expansion isn’t it.

It is however a pathway to bankruptcy and fiscal anemia.

In the early 2000s, we missed the window to fix an unsustainable government program. Less than two decades later, we have a window to avoid making the mistake a second time. The governor or the legislature should seize it and act quickly to end Medicaid expansion and find better solutions to Kentucky’s health care challenges. Our economic future is bleak if we don’t.

Jordan Harris is the executive director of Pegasus Institute, a public-policy think-tank based in Louisville. His views as a columnist do not necessarily reflect the positions of Pegasus Institute.